POSITION SUMMARY

This role is responsible for processing prior authorization requests efficiently while adhering to payer guidelines and policies.

ESSENTIAL FUNCTIONS

Handles complex prior authorization requests, including high-cost medications and procedures.
Serves as a point of contact for escalated authorization issues.
Assists in reviewing insurance policies to ensure compliance with payer requirements.
Coordinates with healthcare providers and insurance companies to resolve discrepancies.
Ensures timely submission and follow-up on authorization requests.
Reviews incoming authorization requests and verifies patient eligibility and benefits.
Initiates prior authorization requests via phone, fax, or online portals.
Tracks and follows up on the status of submitted authorizations.
Communicates approval or denial outcomes to healthcare providers and patients.
Maintains accurate records and documentation of all authorization activities.
Collaborates with the billing and clinical teams to ensure accuracy of information.
Complies with HIPAA rules, appropriately safeguarding PHI or other private & confidential information.
Maintains accurate and detailed notes in the company system.
Adapts quickly to frequent process changes and improvements.
Is reliable, engaged, and provides feedback to improve processes and policies.
Attends all department, team, and weekly company meetings as required.
Appropriately routes incoming calls when necessary.
Meets company quality standards.
Embraces and exemplifies Cardinal Health values:
Invites Curiosity, Builds Partnerships, Inspires Commitment, Develops Self and Others

Qualifications:

(1) At least 2 years of college coursework or experience

(2) At least 2 years of experience in Prior Authorization (Healthcare) is required

(3) Experience in using Contact Center phone system such as NICE and/or Genesys is an advantage

Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply.

Cardinal Health supports an inclusive workplace that values diversity of thought, experience and background. We celebrate the power of our differences to create better solutions for our customers by ensuring employees can be their authentic selves each day. Cardinal Health is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, ancestry, age, physical or mental disability, sex, sexual orientation, gender identity/expression, pregnancy, veteran status, marital status, creed, status with regard to public assistance, genetic status or any other status protected by federal, state or local law.

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Sr. Representative, Customer Service Operations (Prior Authorization)

POSITION SUMMARY

This role is responsible for processing prior authorization requests efficiently while adhering to payer guidelines and policies.

ESSENTIAL FUNCTIONS

Handles complex prior authorization requests, including high-cost medications and procedures.

Serves as a point of contact for escalated authorization issues.

Assists in reviewing insurance policies to ensure compliance with payer requirements.

Coordinates with healthcare providers and insurance companies to resolve discrepancies.

Ensures timely submission and follow-up on authorization requests.

Reviews incoming authorization requests and verifies patient eligibility and benefits.

Initiates prior authorization requests via phone, fax, or online portals.

Tracks and follows up on the status of submitted authorizations.

Communicates approval or denial outcomes to healthcare providers and patients.

Maintains accurate records and documentation of all authorization activities.

Collaborates with the billing and clinical teams to ensure accuracy of information.

Complies with HIPAA rules, appropriately safeguarding PHI or other private & confidential information.

Maintains accurate and detailed notes in the company system.

Adapts quickly to frequent process changes and improvements.

Is reliable, engaged, and provides feedback to improve processes and policies.

Attends all department, team, and weekly company meetings as required.

Appropriately routes incoming calls when necessary.

Meets company quality standards.

Embraces and exemplifies Cardinal Health values:

Invites Curiosity, Builds Partnerships, Inspires Commitment, Develops Self and Others

Qualifications:

(1) At least 2 years of college coursework or experience

(2) At least 2 years of experience in Prior Authorization (Healthcare) is required

(3) Experience in using Contact Center phone system such as NICE and/or Genesys is an advantage